Crr Week 7: Asthma (Levin)

Front 1

Describe the pathophysiology of asthma.

Back 1

1. Inhaled antigens activate Th2 and mast cells
2. Leads to release of inflammatory mediators
3. Induces release of eosinophils from BM
4. Eosinophils travel to lung and release LTs and GM-CSF, which prolongs inflammation response

Front 2

Which cells are particularly active in the pathophysiology of asthma?

Back 2

1. Mast cells
2. T lymphocytes
3. Eosinophils
(these release a wide range of inflammatory mediators)

Front 3

What is the effect of inflammatory mediators on the cells of the respiratory airways?

Back 3

Inflammatory mediators lead to contraction of smooth muscle and edema (due to plasma leakage and mucus plugging)

Front 4

List 3 general ways to diagnose asthma

Back 4

1. Episodic symptoms of airflow obstruction are present
2. Airflow obstruction is at least partially reversible
3. Alternative diagnoses are excluded

Front 5

List the 4 classifications of asthma severity

Back 5

Step 1: Intermittent
Step 2: Mild persistent
Step 3: Moderate persistent
Step 4: Severe persistent

Front 6

List 5 clinical features of Step 1 Intermittant asthma before treatment.

Back 6

1. Symptoms =or<2 times a week
2. Brief exacerbations (a few hrs to a few days)
3. Nighttime asthma symptoms =or<2 times/ month
4. Asymptomatic with normal PFT between attacks
5. FEV1 =or> 80% predicted

Front 7

For the diagnosis of Intermittant asthma, the FEV1 is > or = to ______% predicted

Back 7

80%

Front 8

A person with intermittent asthma will experience daily symptoms less than _____ times a week and nighttime symptoms less than _____ times a month.

Back 8

Daily symptoms < 2 times a week
Nighttime symptoms <2 times a month

Front 9

List 2 PRN short-acting beta-2 agonists

Back 9

1. Albuterol
2. L-albuterol

Front 10

List 3 benefits of using HFA devices

Back 10

1. Ozone safe (CFC free)
2. No priming necessary when used within 2 wks of last dose
3. Reliable delivery up to 200 actuations

Front 11

What are the possible cons of HFA devices?

Back 11

1. Softer, mist-like spray
2. Lower spray force
3. Warmer puff
4. Slight sulfur taste

Front 12

List 4 clinical features seen with Mild persistent asthma (Step2) before treatment.

Back 12

1. Symptoms >2 times a week, but < 1 time/ day
2. Exacerbations may affect activity
3. Nighttime astham > 2 times/ month
4. FEV1 =or >80% predicted

Front 13

Which group of drugs are the basis of anti-inflammatory treatment in all asthma severity greater than "intermittent"?

Back 13

Low dose inhaled corticosteroids (ICS)

Front 14

Which medications are used to treat Step 2 asthma?

Back 14

(mild persistent asthma)

1. *Low dose inhaled corticosteroids
2. Some would consider Cromolyn, Nedocromil, or Singulair (Montelukast)

Front 15

Which medications are used to treat Step 1 asthma?

Back 15

(intermittent asthma)

PRN short-acting Beta-2 Agonists
(albuterol, L-albuterol)

Front 16

Do low-dose inhaled corticosteroids decrease risk of death from asthma?

Back 16

YES.

Front 17

What has been concluded about the effectiveness of LTMs and ICSs as monotherapy for treating adults with asthma?

Is this different with children?

Back 17

ICSs are more effective as monotherapy than LTMs in adults with asthma
(fewer exacerbations were seen with ICSs)

*As for children, there is no conclusive evidence to prove that one is more effective than the other

Front 18

List 6 clinical features of moderate persistent asthma (Step 3) seen before treatment.

Back 18

1. Symptoms DAILY
2. Exacerbations affect activity
3. Exacerbations > 2 times a week; may last days
4. Nighttime asthma symptoms >1 time a week
5. Daily use of inhaled short-acting B2-agonist
6. FEV1 60 - 80% predicted

Front 19

Which medications are used to treat Step 3 asthma?

Back 19

(moderate persistent asthma)

1. Long-acting B2-agonists (LABAs) --> Salmeterol, Formoterol
2. Anti-inflammatory drugs--> medium dosage corticosteroids, leukotriene modifiers

Front 20

Which medication is more effective in treating Step 3 asthma when added to inhaled corticosteroids-- Leukotriene modifiers or long-acting B2-agonists?

Back 20

Long-acting B2-agonists (LABAs) are more effective when added to ICSs

Front 21

Describe the development of an asthma exacerbation.

Back 21

1. Inhaled allergens stimulate the production of IgE by B-lymphocytes
2. B-lymphocytes differentiate into plasma cells, which produce and release IgE antibodies into the circulation
3. IgE circulates in blood and binds to mast cells in the tissue or peripheral-blood basophils.
4. When the subject re-encounters the offending allergen, binding of the allergen with IgE induces release of inflammatory mediators

Front 22

The binding of IgE to a mast cell takes place at which region of the IgE molecule?

Back 22

constant region

Front 23

Which receptor does IgE bind to on mast cells?

Back 23

FceRI
(high affinity receptor)

Front 24

What causes the release of preformed and newly generated mediators from mast cells?

Back 24

When an allergen interacts with receptor-bound IgE molecules, molecular bridging occurs, resulting in activation of the cell and release of mediators.

Front 25

Which anti-inflammatory medication can be used to treat Step 3 asthma?

Back 25

Xolair (omalizumab)

*This medication is VERY expensive!

Front 26

What is the MOA of Omalizumab and what are the advantages of taking it?

Back 26

MOA: inhibits IgE from binding to high-affinity receptors on mast cells and basophils

1. Decreases asthma-related ER visits
2. Decreases daytime/nocturnal symptoms
3. Decreases oral steroid dosage
4. Decreases use of albuterol

Front 27

Which region of IgE does Omalizumab bind to?

Back 27

Constant region

Front 28

List 2 ways that Omalizumab reduces the release of inflammatory mediators from mass cells and basophils.

Back 28

1. Binds free IgE, inhibiting IgE from binding to high affinity receptors
2. Reduces the number of high-affinity receptors on mast cells and basophils

Front 29

An FEV <60% of predicted value is indicative of which level of asthma severity?

Back 29

Step 4 (severe persistent asthma)

Front 30

List 5 clinical features seen in severe persistent asthma (step 4) before treatment

Back 30

1. Continual symptoms
2. Frequent exacerbations
3. Frequent nighttime symptoms
4. Physical activities limited by symptoms
5. FEV1 <60% predicted

Front 31

Which medications are used to treat Step 4 asthma?

Back 31

(severe persistent asthma)

1. High dosage inhaled corticosteroids
2. Oral corticosteroids
3. Theophylline (possibly...)

Front 32

If a patient is experiencing daily asthma symptoms and has a FEV1 70% predicted value, what level of severity is this person's asthma?

Back 32

Step 3

Front 33

An FEV1 50% predicted value would indicate which level of asthmatic severity?

Back 33

Step 4: severe persistent asthma

Front 34

What are the 4 respiratory symptoms that are associated with asthma and required for the diagnosis?

Which is the most common?

Back 34

1. Wheezing
2. Breathlessness
3. Cough
4. Chest tightness <-- MOST COMMON

Front 35

What is the term for the spiral shaped mucus plugs that can be found in the sputum of asthmatics?

Back 35

Curschmann's spirals

Front 36

List the steps of relief therapy that are prescribed asthmatic patients.

Back 36

1. Short-acting inhaled B2-agonist (intermittent patients, only)
2. Anticholinergics
3. Systemic corticosteroids

Front 37

List the order that medications should be prescribed for controlling asthma long-term.

Back 37

1. Inhaled corticosteroids
2. Cromolyn, Nedocromil
3. Leukotriene modifiers, Long-acting B2-agonists
4. Anti-IgE therapy
5. Systemic corticosteroids
6. Sustained release theophylline

Front 38

What is the first line of therapy for controlling asthma?

Back 38

Inhaled corticosteroids

Front 39

What is the first line of therapy for relieving asthma?

Back 39

Short-acting inhaled B2-agonist